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SOME CLINICAL OBSERVATIONS ON HELIOTHERAPY IN PULMONARY TUBERCULOSIS.
1147 their metabolism will be stimulated by the cool air, and they will breathe cool dry air which enhances the flow of blood lymph and secretion in and through the respiratory membrane. The cool air, too, will moderate the action of the sun-rays on the skin. This method has been tried by us with good effect and has proved a valuable supplement to general treatment. We havedesigned shelters on the roof of the sanatorium with walls just high enough to give privacy and open to the sky. It is in the winter, when the snow has fallen, that the ultra-violet rays of the sun are least strong, and the cooling power of the air most in evidence, and it is in the winter, therefore, when the best results from this gentle moderated heliotherapy are to be expected. The winter sun is warm enough and even too warm sometimes at midday. On the other hand, the summer sun is very powerful round about midday. It must be used in the cool early morning hours when the sun is low in the heavens and its rays mostly absorbed by the atmosphere.
SOME CLINICAL OBSERVATIONS ON
HELIOTHERAPY IN PULMONARY TUBERCULOSIS. BY BERNARD HUDSON, M.D. CAMB., CHIEF MEDICAL OFFICER OF THE ENGLISH
SANATORIUM, MONTANA;
AND
LEONARD HILL, M.B.
LOND., F.R.S.,
DIRECTOR OF THE DEPARTMENT OF APPLIED PHYSIOLOGY, NATIONAL INSTITUTE OF MEDICAL RESEARCH.
(With Illustrations
on
Special Plate.)
THE sun-cure is now, thanks to the work of Bernhard and Rollier in Switzerland and Gauvain in England, generally admitted to be the most satisfactory method of treating the large majority of cases of localised or surgical tuberculosis-i.e., tuberculosis of the bones, joints, glands, and serous membranes. On the other hand, the sun treatment of pulmonary tuberculosis has fallen into disrepute and is generally considered Types of Disease Amenable to Heliotherapy. dangerous by experienced medical officers at sanatoria. Heliotherapy may be tried in cases of tuberculosis This is because sun treatment has, in many cases in the past, been tried on pulmonary cases in sun- of the lungs, where the disease is of the localised, boxes open only to the south or under glass, where single-focus type, thereby approximating in character to surgical tuberculosis. In cases where there is no a greenhouse effect has been produced, and because febrile cases have been submitted to such conditions fever and in which the activity of the disease has which overheat in place of cooling the body. More- become arrested, but which are " sticking " and still over, a febrile case is fighting against active have sputum containing tubercle bacilli, much benefit disease. Products of tissue destructior produced may be derived from such a course of sun-baths ; the is stimulated and the sputum and by the bacterial invasion of his tissues are being healing process absorbed and his immunising power is being spitting of tubercle bacilli may cease. Where the disease is of the scattered type, and excited thereby. What he at the moment lacks is sufficient natural response. To sunburn him and especially where there is a liability to fever, either throw extra products of tissue destruction into his periodical or continuous, sun-bathing is dangerous blood is then wrong. His immunising powers are and should not be attempted. Cases which easily themselves and those who are prone to already over-taxed and cannot be further aroused. auto-inoculateshould avoid exposure to the sun, but He needs, if only such could be had, an active anti- haemoptysis tuberculous serum taken from an animal immunised such cases are benefited by exposure to the cool air and ultra-violet radiation of the sky. From exposure against the tubercle bacilli and in open cases against to the sun, on the other hand, good results have the other bacilli which produce secondary infection of the lung. People afflicted with pulmonary tuberculosis been obtained in those instances where the disease have been told, and are sometimes still told, to go to is of the pleural type, with much thickening of the the south of France, the Swiss Alps, or some other pleura and contraction of the chest ; the thickening are absorbed and cleared up, the lung sunny part of the world, and to sit about there in and adhesions the sun, and they will soon be all right again. Theyr expands and functions again, and there is a great take such advice, often with disastrous results. It, general improvement in health. Another type which must be recognised that indiscriminate and uncon- does well is the bronchial asthmatic. As a general rule, it may be stated that where there trolled use of the sun in pulmonary tuberculosis is smouldering activity of the tuberculous process, as fraught with danger and must be vetoed. If appliedL is evidenced by fever, a tendency to auto-inoculate on to the and of sun treatment case, wrongly wrong type and other signs and symptoms exertion, haemoptyses a set in where the disease may up flaming activity lung was, perhaps, only smouldering, and would have of activity, then sun-bathing must be left alone, and ordinary treatment of rest and open air carried settled down under ordinary climatic and hygienic out. Sun-bathing may be used as an additional treatment. stimulus to a case which is becoming cured, but in Method of Treatment. The point, then, is first to select those cases likely which progress is slow. Sun-bathing consists in becoming gradually accusto be benefited by a course of heliotherapy, and, tomed to withstand the of the sun, and should secondly, to endeavour to control the dosage and be commenced slowly, rays and increased regularly of treatment in each instance. First the application to the needs of the patient. The head and of all, it should be clearly recognised that it is not a according be kept covered. Sun-burning should be neck should hot sun which is required, but pleasantly warm avoided, slight erythema followed by pigmentation, sun-light and cool air. The treatment should not be not burning, being what is required. When once carried out in an enclosed space, which is liable to and well on the road to cure the patient pigmented become stuffy and hot, but should be done, as far as If the can stand more and more exposure to the sun. : possible, in the open, with cool fresh air circulating patient becomes fatigued, sweats much, or has a around the freely patient. the time of to the The cool, dry air of the Swiss Alps in winter is one definite febrile reaction, Dark-hairedexposurebecome sun must be cut down. people of the most beneficial factors in the proper application more easily than fair ones to the sun’s of the sun treatment in cases of pulmonary tuberculosis. accustomed some fair and red-haired people find The patients can be exposed with a loin cloth on or in rays ; in fact, to undertake a course of sun-baths. a thin bathing costume on an open roof with theirit impossible Toleration largely depends upon the amount of lounge chairs placed on the snow ; the winter Alpine pigmentation that occurs, but the whole procedure, sun will gratefully warm them while they turn now in pulmonary cases, should be a very their front and now their back to it. At the same time especially tentative one, and most carefully controlled and watched. While much good may be done by sun (Continued from preceding page.) 11. Topley, W. W. C., and Wilson, G. S. : Jour. of Hyg., 1923, treatment, this, if carried out wrongly, may cause a xxi., 243. great deal of harm. 12. Webster, L. T. : Jour. Exper. Med., 1923, xxxvii., 781, andL We are indebted to Mr. P. G. Sutton, radiographer xxxviii., 33 and 45. at the English Sanatorium at Montana, for the 13. Cleveland, L. R. : Amer. Jour. Hyg., 1924, iii., 444. 14. Lankester, E. R. : The Kingdom of Man, 1907, p. 33. photographs. ,
.
I the
.
,
.
SOME CLINICAL OBSERVATIONS ON
HELIOTHERAPY IN PULMONARY TUBERCULOSIS. BY BERNARD HUDSON, M.D. CAMB., CHIEF MEDICAL OFFICER OF THE ENGLISH
SANATORIUM, MONTANA;
AND
LEONARD HILL, M.B.
LOND., F.R.S.,
DIRECTOR OF THE DEPARTMENT OF APPLIED PHYSIOLOGY, NATIONAL INSTITUTE OF MEDICAL RESEARCH.
(With Illustrations
on
Special Plate.)
THE sun-cure is now, thanks to the work of Bernhard and Rollier in Switzerland and Gauvain in England, generally admitted to be the most satisfactory method of treating the large majority of cases of localised or surgical tuberculosis-i.e., tuberculosis of the bones, joints, glands, and serous membranes. On the other hand, the sun treatment of pulmonary tuberculosis has fallen into disrepute and is generally considered Types of Disease Amenable to Heliotherapy. dangerous by experienced medical officers at sanatoria. Heliotherapy may be tried in cases of tuberculosis This is because sun treatment has, in many cases in the past, been tried on pulmonary cases in sun- of the lungs, where the disease is of the localised, boxes open only to the south or under glass, where single-focus type, thereby approximating in character to surgical tuberculosis. In cases where there is no a greenhouse effect has been produced, and because febrile cases have been submitted to such conditions fever and in which the activity of the disease has which overheat in place of cooling the body. More- become arrested, but which are " sticking " and still over, a febrile case is fighting against active have sputum containing tubercle bacilli, much benefit disease. Products of tissue destructior produced may be derived from such a course of sun-baths ; the is stimulated and the sputum and by the bacterial invasion of his tissues are being healing process absorbed and his immunising power is being spitting of tubercle bacilli may cease. Where the disease is of the scattered type, and excited thereby. What he at the moment lacks is sufficient natural response. To sunburn him and especially where there is a liability to fever, either throw extra products of tissue destruction into his periodical or continuous, sun-bathing is dangerous blood is then wrong. His immunising powers are and should not be attempted. Cases which easily themselves and those who are prone to already over-taxed and cannot be further aroused. auto-inoculateshould avoid exposure to the sun, but He needs, if only such could be had, an active anti- haemoptysis tuberculous serum taken from an animal immunised such cases are benefited by exposure to the cool air and ultra-violet radiation of the sky. From exposure against the tubercle bacilli and in open cases against to the sun, on the other hand, good results have the other bacilli which produce secondary infection of the lung. People afflicted with pulmonary tuberculosis been obtained in those instances where the disease have been told, and are sometimes still told, to go to is of the pleural type, with much thickening of the the south of France, the Swiss Alps, or some other pleura and contraction of the chest ; the thickening are absorbed and cleared up, the lung sunny part of the world, and to sit about there in and adhesions the sun, and they will soon be all right again. Theyr expands and functions again, and there is a great take such advice, often with disastrous results. It, general improvement in health. Another type which must be recognised that indiscriminate and uncon- does well is the bronchial asthmatic. As a general rule, it may be stated that where there trolled use of the sun in pulmonary tuberculosis is smouldering activity of the tuberculous process, as fraught with danger and must be vetoed. If appliedL is evidenced by fever, a tendency to auto-inoculate on to the and of sun treatment case, wrongly wrong type and other signs and symptoms exertion, haemoptyses a set in where the disease may up flaming activity lung was, perhaps, only smouldering, and would have of activity, then sun-bathing must be left alone, and ordinary treatment of rest and open air carried settled down under ordinary climatic and hygienic out. Sun-bathing may be used as an additional treatment. stimulus to a case which is becoming cured, but in Method of Treatment. The point, then, is first to select those cases likely which progress is slow. Sun-bathing consists in becoming gradually accusto be benefited by a course of heliotherapy, and, tomed to withstand the of the sun, and should secondly, to endeavour to control the dosage and be commenced slowly, rays and increased regularly of treatment in each instance. First the application to the needs of the patient. The head and of all, it should be clearly recognised that it is not a according be kept covered. Sun-burning should be neck should hot sun which is required, but pleasantly warm avoided, slight erythema followed by pigmentation, sun-light and cool air. The treatment should not be not burning, being what is required. When once carried out in an enclosed space, which is liable to and well on the road to cure the patient pigmented become stuffy and hot, but should be done, as far as If the can stand more and more exposure to the sun. : possible, in the open, with cool fresh air circulating patient becomes fatigued, sweats much, or has a around the freely patient. the time of to the The cool, dry air of the Swiss Alps in winter is one definite febrile reaction, Dark-hairedexposurebecome sun must be cut down. people of the most beneficial factors in the proper application more easily than fair ones to the sun’s of the sun treatment in cases of pulmonary tuberculosis. accustomed some fair and red-haired people find The patients can be exposed with a loin cloth on or in rays ; in fact, to undertake a course of sun-baths. a thin bathing costume on an open roof with theirit impossible Toleration largely depends upon the amount of lounge chairs placed on the snow ; the winter Alpine pigmentation that occurs, but the whole procedure, sun will gratefully warm them while they turn now in pulmonary cases, should be a very their front and now their back to it. At the same time especially tentative one, and most carefully controlled and watched. While much good may be done by sun (Continued from preceding page.) 11. Topley, W. W. C., and Wilson, G. S. : Jour. of Hyg., 1923, treatment, this, if carried out wrongly, may cause a xxi., 243. great deal of harm. 12. Webster, L. T. : Jour. Exper. Med., 1923, xxxvii., 781, andL We are indebted to Mr. P. G. Sutton, radiographer xxxviii., 33 and 45. at the English Sanatorium at Montana, for the 13. Cleveland, L. R. : Amer. Jour. Hyg., 1924, iii., 444. 14. Lankester, E. R. : The Kingdom of Man, 1907, p. 33. photographs. ,
.
I the
.
,
.